Category: Child Development

It is often portrayed as a happy and exciting time but the experience of pregnancy can be mixed, with physical and mental complications dampening the experience.

In a recently released documentary, Moms and Meds, director Dina Fiasconaro addresses the challenges that she and other women with psychiatric disorders face during pregnancy.

Fiasconaro’s goal in making the documentary was to investigate women’s experiences with psychotropic drugs at this life stage. She became pregnant while on anti-anxiety medication and had difficulty obtaining clear information from healthcare professionals.

In an interview with the Trauma and Mental Health Report, Fiasconaro explained:

“I received very conflicting information on what medications were safe from my psychiatrist, therapist, and high-risk obstetrician. Even with non-psychiatric medication, I couldn’t get a clear answer, or from the pharmaceutical companies that manufactured them. No one wanted to say ‘that’s okay’ and be liable if something were to go awry.”

When she spoke to her maternal/fetal specialist, she was provided with a stack of research abstracts regarding the use of certain psychotropic medications during pregnancy. Although the information was helpful, it didn’t adequately inform her about the risks and benefits of medication use versus non-use.

One of the main questions Fiasconaro had was, should she continue using medication and risk harming her baby, or should she discontinue use and risk harming herself?

One of the women featured in Moms and Meds, Kelly Ford, contemplated suicide several times during pregnancy. When her feelings began to intensify, she admitted herself to a hospital. There, she was steered away from taking medication which led her to feel significant distress and an inability to cope with her declining mental health.

Elizabeth Fitelson, director of the Women’s Program at Columbia University, also featured in the documentary, believes there is a tendency for healthcare professionals to dismiss mental illness in pregnant women.

In the film, Fitelson said:

“If a pregnant woman falls and breaks her leg, for example, we don’t say, ‘Oh, we can’t give you anything for pain because there may be some potential risk for the baby.’ We say, ‘Of course we have to treat your pain. That’s excruciating. We’ll give you this. There are some risks, but the risks are low and, of course, we have to treat the pain. ‘”

This lack of validation for mental health issues was echoed by Fiasconaro when she visited her doctor:

“I was referred to a high-risk obstetrician by my therapist. Although I was given the proper advice, that high-risk doctor ended up being very insensitive to my mental illness. She told me that everybody’s anxious and brushed it off like it was a non-issue. I understand that in the larger context of what she does and who she treats, my anxiety probably seemed like a low priority in the face of other, seemingly more threatening, physical illnesses.”

The ambiguous information provided by health professionals is representative of a lack of research on the risks of using medication during pregnancy.

Mary Blehar and colleagues, at the National Institutes of Health (NIH), state in the Journal of Women and Health that data are lacking on the subject. In a review of clinical research on pregnant women, they found that data obtained over the last 30 years, about which medications are harmful and which can be used safely, are incomplete. These gaps are largely due to the majority of information being based on case reports of congenital abnormalities, which are rare and difficult to follow.

During her pregnancy, Fiasconaro was able to slowly stop taking her anxiety medication. But halting treatment is sometimes not an option for women who suffer from severe, debilitating psychiatric conditions such as bipolar disorder, major depression, or schizophrenia.

We also need to improve access to information on pharmacological and non-pharmacological treatment options, including psychotherapy for women with mental-health problems during pregnancy. Without adequate guidance, the management of psychiatric conditions can leave many feeling alone and overburdened. These women often feel stigmatized and neglected by healthcare professionals. The development of supportive and informative relationships is necessary to their wellbeing.

As Fiasconaro put it:

“I had to be pretty focused and tenacious in finding information and then making the most informed decision for myself. I’m grateful I was able to do so, but again, I know every woman might not be in that position, and it can be very scary and confusing.”

As a counselor, social worker, or therapist, how do you begin conversations with your clients? What are the best ways to break the ice and generate meaningful discussions? These are questions that Jane Evans, trauma, parenting and behaviour expert, found to be common among her colleagues in the field.

Evans is a therapist and member of NEYTCO, the National Early Years Trainers and Consultants Organization, located in the UK. She has spent over 20 years working with parents and children who experience difficulty in relationships.

In an interview with the Trauma and Mental Health Report, Evans explains:

“I find that many practitioners don’t entirely understand childhood trauma and they struggle to talk to parents about it.”

To facilitate more open dialogue, Evans created Fink Cards—a conversation tool that provides structure to therapy sessions and helps therapists and clients engage in meaningful discussions. The Cards list questions to help parents who have trouble communicating and forming a good relationship with their children. And the Cards help parents and families who have encountered trauma in the past.

Since Evans sees trauma as a major factor in difficult parent-child relationships, she directly addresses this issue with the Fink Cards. They ask questions like “what does the word trauma make you think about?” to open the door to therapy work. The Cards support the counselor in facilitating discussion, and assist clients.

Evans found, while working with families, that parents are not always aware of how their own actions, as well as their interactions with the child, may in fact perpetuate problem behaviours. She says:

“Most parents see the child as the problem; they’re always aiming to fix the child. However, these cards invite them on a different journey. Parents consider what has happened early in their own lives or in their child’s early years and how that impacts their child’s behaviour now.”

Questions like “who was in charge of discipline when you were a child?” and “who notices when you are worried or anxious?” help parents reflect on how their early experiences and current support systems shape their parenting practices, as well as any negative impact these may be having on the child. As parents consider how these events impact their parenting choices, the therapist is able to work with them to implement more effective methods of communication and alternative coping strategies.

Research has shown that conversation cards can help patients become more open about their feelings. In a study conducted by researchers at Stratheden Hospital in the UK, 6D cards were used to facilitate holistic, patient-led communication. 6D cards are a type of conversation card developed to help physicians and nurses ensure a meaningful consultation with female patients in a gynecology clinic. They contain six categories, or dimensions, of health, including healthcare, emotions, lifestyle, interpersonal relationships, symptoms, and life events. The purpose of these cards is to allow the patients to lead the conversation.

Another study, conducted by the Design Council of the UK and the Bolton Primary Care Trust, focused on creating stronger methods of communication and management for diabetic patients with the use of Agent Cards, which are similar to both the 6D and Fink Cards. Agent Card statements encourage patient-led conversations with practitioners. Results of the study showed that using the cards helped facilitate more open discussion.

With Evans’ Fink Cards, clients have the freedom to choose questions from four categories during sessions: the parent’s early childhood and upbringing; the parent’s relationship with his or her child; the parent and child’s worries and anxieties; and how early trauma may have affected the child.

“These cards are a way of having difficult conversations, but it’s not just me putting the questions to the patient and saying ‘you have a problem,’” Evans explains.

While the effectiveness of Fink Cards does require more research, they have already made their way into the marketplace, and look to be a promising resource in clinical settings. Sometimes building rapport or discussing sensitive topics with a client can be difficult, but Fink Cards may go a long way in helping therapists and clients ease into healthy conversations in an educational and comfortable way.

“My aunt woke me to say that my mom sent a text to the family priest in the middle of the night, asking for prayers after taking a bunch of pills.”

Diagnosed with clinical depression, Keith Reid-Cleveland’s mother had a long, painful history of suicide attempts, feeling unhappy and tired much of the time. Like many children, he felt helpless and didn’t understand depression, thinking her fatigue was from hard work, and that his mother just needed sleep.

As Reid-Cleveland grew up, he began to take notice of his mother’s mood, making it his responsibility to try to make her smile:

“At first, this just entailed telling her ‘I love you’ every time I saw her. Eventually, it morphed into me acting as sort of a motivational life coach/stand-up comic.”

“I sat down and unpacked what was bothering her step-by-step, until she realized it wasn’t as devastating as she’d thought.”

The Canadian Mental Health Association (CMHA) estimates that 8% of adults will experience major depression at some point in their lives. About 4000 Canadians die each year by suicide, making it the second leading cause of death for those between ages 15 and 34.

Parental suicide and hospitalization have a tremendous impact on children.

To better understand this traumatic experience, researchers Hanna Van Parys and Peter Rober, from the University of Leuven in Belgium, conducted interviews with children between ages 7 and 14 who had a parent hospitalized for major depression.

Many children showed sensitivity to the parent’s distress. Like Reid-Cleveland, some reported awareness of parental fatigue or lack of energy. Others picked up on mood changes, such as when the parent was feeling angry or sad. And some reported feeling guilty for being a burden.

Eleven-year-old Yellow expressed to his father: “If you would like me to be somewhere else sometimes, just tell me.”

Others sought ways to convey to their parents that they were not affected by their mental health, attempting to elevate mom’s or dad’s mood. Van Parys and Rober consider this behaviour common for children seeing a parent in distress. In their study, a child named Kamiel was asked whether he would like to solve problems for his mother, to which he responded: “Yes, sometimes, if that would be possible,” while hugging her closely.

When his mother was first hospitalized for a suicide attempt, Reid-Cleveland’s loved ones decided he shouldn’t see her. Recalling similar situations of parental hospitalization, child interviewees reported much distress and worry about the parent. Many felt alone, powerless, unable to help.

One girl expressed existential fear, stating: “Then I think about when you will die, everything will be different when you die.” Seeing a parent in the hospital forces the child to imagine life without them.

Research shows that children of parents who attempt suicide are at higher risk to do the same. And in a study conducted at the Aarhus University in Denmark, researchers found an increased long-term risk of suicide in children who experienced parental death in childhood, increasing suicide risk for up to 25 years following the traumatic experience.

Like Reid-Cleveland, many children living with parent mental illness feel isolated and helpless. Van Parys and Rober note that prevention programs focusing on family communication are beneficial to enhance family resilience, and to lessen the burden on the child.

On December 19, 2015, former National Hockey League (NHL) player Patrick O’Sullivan revealed shocking details of sports-related childhood abuse. In a blog article on The Players Tribune, he disclosed that his father began abusing him at 5 years old when he got his first pair of hockey skates.

At the age of 10, it worsened:

“It would start as soon as we got in the car, and sometimes right out in the parking lot.”

He reveals that his father would put out cigarettes on his skin, choke him, and throw objects at him. At times, he endured whippings with a jump rope or an electrical cord.

“As twisted and insane as it sounds, in his mind, the abuse was justified. It was all going to make me a better hockey player—and eventually get me to the NHL.”

Patrick’s father assumed that these harsh disciplinary practices would enhance his abilities and success, but experts say otherwise. The scars of childhood abuse have a lasting negative impact.

John O’Sullivan (no relation to Patrick), a former soccer player, coach, and founder of the Changing the Game Project, says this parenting behaviour burdens the child, hindering performance.

In an article on the Changing the Game Project website, John writes:

“If a child believes that a parent’s love is tied to the expectation of winning, and he does not win, he may believe that he is less loved or valued. This creates anxiety and inhibits performance.”

Childhood maltreatment leads to decreased mental and physical health, even decades after the abuse. Rutgers sociology professor Kristen Springer and colleagues reported that, in their population based survey, physical symptoms and illnesses, like hypertension and cardiac problems, were present in those who experienced childhood abuse years earlier. And childhood maltreatment is also associated with increased anxiety, anger, and depression—symptoms that can be heavily detrimental to an athlete’s performance.

Some studies also show that early childhood maltreatment, such as the abuse endured by Patrick, shape aspects of socio-emotional development in adolescence and adulthood. A study conducted by Pan Chen and colleagues at the University of Chicago supported the relationship between childhood abuse and aggressive behaviour in adulthood. The researchers note that early trauma may increase impulsive behaviour and lashing out in abuse survivors.

But some, like Patrick, seek help. He says in an interview with ESPN, “…I have put the money and time into my own health.”

He acknowledges that not everyone has the opportunity to find the help they need—especially as an athlete:

“Players don’t feel like they can say anything because it’s a huge red flag. You say you need to see a psychologist and you’ll get a call from your agent saying he spoke to the General Manager of the team and wants to know what your ‘problem’ is.”

In addition to how isolating the experience of abuse can be for professional athletes and adults, Patrick emphasizes how helpless and frightening it can be for a child. He describes his own feelings of disempowerment, at the age of ten: “I just tried to survive. Each morning, I’d wake up and think: Here we go again. Just get through it.”

It didn’t help that others turned a blind eye. Patrick says that parents and coaches would catch a glimpse of the abuse, but no one stepped in. Bystanders may feel hesitant to intervene, out of fear of being wrong. But he counters, “If you are wrong, that’s the absolute best case scenario.” He hopes his story will raise awareness about childhood abuse in young athletes.

As for parents, soccer coach John O’Sullivan says that empowerment may be key to promoting competitive success, instead of harsh discipline and criticism. “The best players play with freedom, they play without fear and they are not afraid of making errors, they can play up to their potential,” he says in an interview with Kids in The House.

He shares that “I love watching you play” are the best five words you can say to a child after a game. “Because when you tell your kids, after a game, that ‘I love watching you play’, what you do is you free them from the burden of being responsible for your happiness as a parent”.

Schools lay the groundwork for cognitive development, especially in academic areas. But what about emotional development? Proficiency in that is equally important for leading a successful life. Yet, little effort has been made in school to teach children how to manage their feelings.

With the introduction of RULER, this may not be the case for much longer. More and more schools around the U.S. are implementing the program aimed at teaching students—and teachers—to ‘Recognize, Understand, Label, Express, and Regulate’ emotions.

Supported by the Yale Center for Emotional Intelligence, it incorporates social and emotional skills training into the school curriculum to support child development. Specific curricula are available from kindergarten to grade 12, and ongoing implementation is necessary to solidify these skills as children get older.

“They’ve started to teach students about feelings as explicitly as they teach math and reading,” writes Seattle Times education reporter John Higgins.

The program is based on the work of two psychologists, John Mayer and Peter Salovey, who began their scientific study of emotional intelligence over two decades ago. They focus on a direct link between critical-thinking skills and emotions.

According to Meyer and Salovey emotional intelligence is the ability to identify, monitor, and manage the emotions of others and oneself, to guide actions and ways of thinking.

Studies show that those who are reluctant to understand and express their feelings experience higher levels of anxiety, depression, and certain psychiatric disorders. They also report lower levels of well-being and social support.

At school, children experience a wide range of emotions every day. In addition to the stress of managing their studies and homework, they face a number of social struggles, such as conflicts with friends, romantic relationships, and bullying.

Marc Brackett, Director of the Yale Center for Emotional Intelligence, and one of the developers of RULER, says that the way students feel at school has a profound effect on how they learn, influencing their chances of success at school, at home, and with friends. And some individuals are generally more successful at handling emotions than others.

Through different tools, RULER provides a common language for expressing emotions, for dealing with conflicts between students, and for addressing conflicts between students and teachers, making for an open and supportive environment necessary for learning. For example, the “mood meter,”—a sheet of paper divided into four coloured quadrants—is designed to help students build a vocabulary around different emotions.

“I have a teacher who checks in with the Mood Meter on Monday mornings and it’s nice to just know that someone’s listening. It gets us in the mood to work, eases us back into school,” explains a grade 11 high-school student in the program.

Other tools, such as the “meta-moment”, train students to use the few seconds following a moment of anger to take a deep breath and imagine how their “best self” would react.

One 7-year-old student talks about her experience with the meta-moment:

“When I’m not in a good mood, RULER can help me solve the problem. Like when my brother pushed sand on my sand castle and wouldn’t fix it. I felt really angry at him, but I took a meta-moment and realized it wasn’t hard to fix what he did and he didn’t do it on purpose. Then I felt a little more forgiving.”

Some are critical of social and emotional learning initiatives within a classroom setting, arguing that schools are not an appropriate venue for emotional education. Others emphasize the price-tag; an online resource and four days total of in-person training costs $10,500 per school (for up to three participants).

However, Brackett’s research shows that implementing RULER can improve a school’s climate while fostering positive development and academic achievement among its students. Some notable improvements include better relationships between students and teachers, more student autonomy and leadership, improved academic success, and fewer reports of bullying.

Students’ mental health profiles greatly improve as well. Kids and adolescents who are involved with this program have experienced reduced levels of anxiety, depression, aggression, hyperactivity, social stress, and alcohol and drug usage. And research shows how children’s ability to handle their emotions and to be mindful of others’ feelings has a significant effect on their mental health.

Not all children come with the tools necessary for academic and social success. Programs like RULER provide a platform for children to learn how to navigate emotional struggles, so they can leave their primary education with methods to succeed in their work and personal lives.

In September 2015, the Supreme Court of British Columbia, Canada, ruled that a mother, known only as ‘B.R.’, could no longer leave her eight-year old son home alone for two hours after school. As reported in a Vancouver Sun article by Brian Morton, this court decision implies that children under the age of ten cannot be left unsupervised under any circumstance.

The implications of this case reach far beyond B.R.’s personal story, and may have serious consequences, raising questions around babysitting, and even whether parents can leave children alone in the house to fetch something from the backyard or to have a conversation with the neighbours.

The ruling is seen by some as reflecting a shift toward helicopter parenting, where parents “hover”, rarely leaving children alone or allowing them to make their own decisions. This consistent interference may in fact hinder a child’s development.

Kathleen Vinson, a professor at Suffolk University, views parental hovering as preventing children from gaining a sense of independence and privacy, which in turn can impede a child’s ability to mature into a healthy, responsible adult later in life. In her research, Vinson found that:

“…the impact of having helicopter parents may have resulted in children’s under-involvement in decision-making; reduced ability to cope; and lack of experience with self-advocacy, self-reliance, or managing personal time.”

Vinson’s research highlights a helplessness and lack of control that many of these children feel. As they move through adolescence to enter university and an increasingly competitive job market, these young adults may find it difficult to juggle the stress brought on by sudden autonomy.

Similar views are expressed by Lenore Skenazy, author of the blog Free Range Kids.With tongue-in-cheek, this self-proclaimed “world’s worst mom” speaks out against tactics such as GPS-tracking one’s children. She supports the idea that it is normal for both parents and children to make mistakes. According to Skenazy, these experiences are an opportunity for a child to develop and mature:

“Childhood is not a crime. Down time is not dangerous. In fact, it’s the fertile soil where creativity takes root. Do you wish you’d grown up with your mom tracking your every move? If not, don’t do it to your own kid.”

But parents often believe they are doing the right thing. Over-attentiveness may come from a place of genuine concern, and the consequences of leaving one’s children unattended.

A Parents Magazine article explains that for many, even the smallest failure or accident can seem disastrous, especially if parental involvement could have prevented it.

And parental involvement is a crucial aspect of a child’s mental health and development. In their textbook, Home and School Relations, University of North Dakota professors Glenn Olsen and Mary Lou Fuller examine the impact of parental participation in children’s education. The authors found that children whose parents showed more interest and involvement in their growth tended to excel academically across multiple domains, including classroom performance and standardized testing—a trend that continued well into higher education.

“Tomorrow is the day of retribution, the day in which I will have my retribution against humanity, against all of you.”

Elliot Rodger spoke these words in a video he recorded before stabbing and shooting fellow students at the University of California, Santa Barbara (UCSB) in May 2014. After killing six and injuring 14 others, Rodger took his own life.

In a 140-page manifesto called “My Twisted World,” Rodger explained that he was seeking revenge for being a virgin at 22 years of age. Tormented by loneliness and rejection, he detailed many painful experiences that helped push him over the edge. In a final video, he threatened the life of every female student in UCSB’s most popular sorority house and anyone else he saw on the streets of Isla Vista.

Rodger sent this manifesto to his parents and therapist before the killing spree, blaming them for his sexual frustrations. His father, Peter Rodger, later explained that his son began dealing with mental health problems at a young age, following his parents’ divorce. In an interview with Barbara Walters on ABC’s 20/20, Rodger’s father spoke about Elliot’s fear of interaction with other children in high school:

“He felt the inability to get along with them. And this is when we realized that he had a real fear of other human beings, of other kids his age.”

Stories like those of Elliot Rodger lead us to seek explanations. We try to understand how something like this can occur. In the 20/20 interview, one explanation advanced was the idea that Rodger’s life changed when his parents divorced.

Source: Yuliya Evstratenko/Shutterstock

The idea of divorce being profoundly damaging to children offers a compelling explanation when it is otherwise difficult to understand certain individual actions. Research shows that children who experience divorce at a young age may develop separation anxiety and dependency. When they do not receive equal attention from both parents, they may become sensitized to rejection and react strongly to this same type of rejection in social situations. Over time, they may develop lower self-esteem and negative expectations regarding intimate relationships.

But even among this small fraction of children, severe aggression is rare. In fact, most children of divorce are able to cope relatively successfully with their situation and go on to develop close relationships, experiencing few behavioral problems. Yet it remains common to view divorce as being destructive for children.

Janine Bernard of Purdue University and Sally Nesbitt of the Counseling and Psychological Services Center in Texas both found no significant differences in levels of anger, aggression, and passive-aggressiveness between children of divorced or disrupted families and children of intact families. In their two-part study, they found that while all children are affected by the quality of their parents’ relationship, environmental and sociocultural factors are just as important in determining individuals’ temperament. Similarly, internal levels of maturity, personal coping styles, and other relationships can and often do counterbalance the negative impacts of divorce.

Bernard and Nesbitt note:

“For generations couples have been disillusioned by the marriage myth, which promised life happily ever after. The more recent divorce myth is equally dogmatic and suggests that divorce has inordinate powers to hurt people regardless of the mental health and maturity of the adults and children involved.”

People with such views tend to expect children from divorced families to become socially isolated and develop behavioral problems. Bernard and Nesbitt explain that this is a common hypothesis among researchers conducting divorce studies. The bias may impact their judgment and cause stilted reporting of results, with more focus on a child’s negative behavior and less on their positive qualities.

Source: Eva Bennett on flickr

Elliot Rodger is an example of one individual who was psychologically disturbed and viewed his parents as responsible for his suffering. But he is certainly not a typical example of a child of divorced parents.

His social isolation may have felt unbearable to him, and he and his family sought an explanation for his violent actions, just as we all do when we hear about tragic stories like this. But our best explanations can be misguided. Reliably predicting violent behavior is still difficult to do.

Walter Mischel, a psychologist best known for the Marshmallow Test, produced his first book at the age of 84.

The Marshmallow Test: Mastering Self-Control hit bookshelves in the fall of 2014, and became an instant media sensation. Part memoir and part scientific analysis of Mischel’s work on self-control, the book reviews research on the Marshmallow Test, which he first carried out at Stanford University, and which has since been replicated around the world.

The Marshmallow Test is a way of assessing children’s capacity for delaying gratification and resisting temptation. Children are placed in a room by themselves and given one marshmallow. An experimenter explains that if the child waits 15 minutes, they will receive a total of two marshmallows to eat. If they don’t wait, they’ll receive only one. After the experimenter leaves the room, the child is observed through a one-way mirror or recorded. The longer a child is able to wait, the greater the ability to delay gratification.

Many videos of children taking the Marshmallow Test have been posted to YouTube, often showing amusing coping strategies children use to maintain restraint. The Marshmallow Test has been so widely popularized that even the Wall Street Journal referred to it in assessing a proposed budget by U.S. president Barack Obama.

In his book, Mischel looks at the correlation between outcome on the test at age 5 or 6 with social skills and academic performance later in life. Results show that children who are able to wait longer for two marshmallows have better social skills and higher academic test scores. The book provides several explanations for this phenomenon, including the possibility that the Marshmallow Test accesses characteristics, such as delay of gratification, that are related to developing positive social skills and performing well academically later on.

For those seeking a step-by-step guide to improve self-control and achieve higher grades, this is not the right book. Mischel discusses theoretical concepts and summarizes research. Although he integrates many personal narratives to add a human touch, the book is not meant as a guide to self-improvement.

With critical and thorough analysis, Mischel instead explains how genetic, environmental, and social factors can impact self-control. He emphasizes that self-control is not predetermined or universal across all areas of an individual’s life. Someone who shows a great deal of control in academia may struggle to show that same level of control when overcoming problem drinking.

Making the content more personal, Mischel often incorporates his own challenges with overcoming a nicotine addiction and how his research was often affected by observations of his own children.

Empowerment is another important issue discussed throughout the book. In one section, Mischel refers to his time as a trainee in a clinical psychology doctoral program, recalling how he watched his mentor, George Kelly, work with an extremely anxious woman. The woman had asked Dr. Kelly, “Am I falling apart?” to which he replied, “Would you like to?”

Using this case, Mischel shifts the focus from the Marshmallow Test and how it might predict future action to how perceived self-control can impact demonstrated self-control. This is an idea that Mischel calls the ‘The Engine of Success.’

The idea is that there are essential resources nurturing and cultivating self-control. Mischel explains this theory through the case of George, a student completing his bachelor degree on a full scholarship at Yale University.

At the age of nine, George was enrolled in a KIPP school, which is an American charter school. Mischel explains how such schools attempt to integrate self-control, self-discipline, brain development, and delay of self-gratification into their curriculum. He emphasizes the need for more schools like this.

Although the original Marshmallow Test predicts a specific type of self-control in later life, Mischel stresses that self-control is fluid. Taking control of any area of your life, he suggests, starts with asking the very question George Kelly asked his client: Would you like to?

It is a life of deafening silence, colourless walls, and empty corridors, a life of intense longing and disappointment. For over 600,000 children living in Russian orphanages waiting to be adopted, it is the only life they know.

In 2013, Russia passed a law to ban the adoption of orphaned children by American citizens, in part because of tense political relations between the two countries. In 2014, Russia also banned the adoption of orphans into any country that acknowledges same-sexmarriage in order to “protect children’s psyche from the undesirable effects of exposure to unconventional sexual relationships.”

With these measures in place, finding homes for orphans outside the country has become very difficult.

Meanwhile, adoption within the borders of Russia faces its own set of barriers. Cultural prejudice against adoption perpetuates feelings of rejection among orphaned children and contributes to fears amongst potential adoptive parents that orphans have inherited undesirable traits and tendencies from their biological parents.

As one adoptive parent, Vera Dobrinskaya, stated in a BBC interview, many orphanage staff members discourage adoption when meeting with prospective parents. She quoted a nurse as saying to her, “Their parents abandoned them, and you want to take care of them?”

Unlike orphans in other countries, 95% of Russian orphans have at least one living parent. Often, they are taken forcibly into state custody because of family illness, disability, or poverty.

While institutions manage to provide for children’s basic physical needs, most Russian orphanages fail to take mental health into consideration. Research has shown that mass institutionalization and the absence of regular adoption practices harm children’s health and development.

To make matters worse, the interaction of staff members and children in these facilities is minimal and conducted in a formal manner, with little warmth or emotion. Daily activities like waking up, showering, dressing, and feeding are carried out in a militaristic way.

As the BBC explains, the problem of Russian orphanages is mainly in their self-identification as warehouses for unwanted children.

Georgette Mulheir, an advocate in the movement to end child abuse, explains why mental health neglect is a problem for these children in a recent TED Talk. While visiting a Russian orphanage, Mulheir reported seeing rooms lined with rows of barred beds, with children quietly gazing up at the ceiling. Newborns also lay in silence, often wearing soiled diapers but not crying, unfamiliar with the help that comes from attentive caregiving. And the head nurse proudly told Mulheir, “You see, our children are very well-behaved.”

Lacking proper stimulation and without secure attachment, many children develop odd and often self-injurious behaviours, such as rocking back and forth or banging their heads into walls. Just as healthy attachment between children and caregivers provides a sense of security for psychological, emotional, and physical development, lacking appropriate caregiving can seriously damage mental health.

As Stephen Bavolek, in the field of child abuse suggests, some of the problems these children can expect as they grow up include poor impulse control, impaired foresight, and a lack of trust in and affection for others.

Several months after the Russian adoption bans were implemented, the United Nations held a meeting to develop alternate childcare programs. Local governments within Russia were instructed to begin transferring children from orphanages to foster families.

This process, however, has encountered resistance from the institutional staff. As child rights protection activist, Maria Ostrovskaya, explains, “Institutions reject sending children into families, as state funding brings jobs and paychecks.”

The situation remains unresolved while many thousands of children wait for politicians to decide their fate. The stakes are high, as many of the children grow up with a risk of being sold into slavery, committing crimes, entering prostitution, or taking their own lives.

But how do we understand the limits, especially where children are concerned?

In 2014, fifteen-year-old Renata underwent nose and chin surgery to put an end to the constant bullying she was facing at school.

The teasing had become so bad that Renata was homeschooled for three years. And while she says that she is happy with the end results, there was great concern raised at the time by parents, health professionals, and the public over the surgeries.

Experts are split on whether children can benefit from undergoing plastic surgery to avoid bullying. But it should be acknowledged that Renata’s story is not that uncommon.

Fourteen-year-old Nadia Ilse, as well as 7-year-old Samantha Shaw, both had surgery to pin back their ears in response to bullying. They had the operations done for free by the Little Baby Face Foundation, a non-profit organization dedicated to correcting facial deformities of children from low-income families. Founder Thomas Romo tells NBC News that such procedures can have a positive impact on a child’s functioning:

“You take a child, and you change the way they look. To anybody who sees them, they’re good looking. That gives the child strength. We can’t go after the bully. But we can try and empower the children.”

A study by the Department of Psychology at the University of the West of England supports the idea of this kind of surgery, which can have a positive impact on mental health. In a pre- and post-operation comparison of 51 plastic surgery patients and 105 general surgery patients, the plastic surgery group experienced a greater decrease in their depression and anxiety.

But the extent of these positive results is questionable.

Over the course of 13 years, the Norwegian Social Research Institute studied body satisfaction in over 1,000 adolescent females, 78 of whom underwent cosmetic surgery. They found that although satisfaction with the specific body parts that were operated on increased, overall body satisfaction did not improve. Furthermore, participants who underwent cosmetic surgery had an increase in depression, anxiety, and substance abuse compared to those who had no surgery, suggesting that the positive mental effects of plastic surgery are localized and short-lived.

Child psychologist Nava Silton also tells Fox 9 News that plastic surgery could be covering up underlying emotional or mental health issues that a child might have, such as low self-esteem. Unaddressed emotional issues could lead to a plastic surgery addiction in adulthood.

Currently, there is no pre-surgery screening process for mental health issues. The American Board of Plastic Surgery (ASPS) recommends children only have plastic surgery if they understand the benefits and drawbacks, do not have unrealistic expectations, and initially requested the plastic surgery themselves. Yet media personality Laura Schlessinger questions a child’s ability to demonstrate such qualities, noting the importance of parents in guiding their children towards better decisions:

“Children, by virtue of their lack of maturity, may have exaggerated notions of how these procedures will improve their lives.”

Still, Renata insists that surgery was the right choice for her—one that she says boosted her confidence enough to return to school.

Children of different ages and different cognitive abilities vary in their ability to appreciate what they are getting themselves into, but wherever possible, it’s important to help them be realistic about the anticipated consequences of a surgical procedure that will change them permanently.